Cardio Notes: Societies Issue Top 10 List

The top 10 advances in heart disease and stroke research are identified, and the safety of dabigatran (Pradaxa) will be examined again.

Prevention Guidelines Head 2013 Advances

As the new year began, the American Heart Association (AHA) and American Stroke Association (ASA) looked back on the biggest scientific advances in heart disease and stroke for 2013, identifying 10 areas of research worthy of inclusion.

Leading the list was the new set of prevention guidelines covering the assessment of atherosclerotic cardiovascular disease risk and management of weight, lifestyle, and cholesterol that were released in November in collaboration with the American College of Cardiology. The guidance sparked controversy, mostly centered around the removal of treatment targets for LDL cholesterol, a new risk calculator, and recommendations widening the potential pool of patients eligible for statins.

Other advances highlighted by the AHA/ASA included hypertension control, cardiovascular health in children and young adults, cardiac rehabilitation, the genetics of congenital heart disease, how intestinal bacteria affect cardiovascular disease risk, atrial fibrillation, therapeutic hypothermia in cardiac arrest, endovascular stroke treatment, and more neutral results for niacin.

"To become a nation of healthier people who live longer, better quality lives, it's important to reflect on the progress we've made," said AHA president Mariell Jessup, MD, of the University of Pennsylvania in Philadelphia, in a statement.

The current protocol "aims to assess systematically the rates of bleeding and thromboembolic outcomes associated with the use of dabigatran and warfarin for patients with atrial fibrillation using data from the FDA Mini-Sentinel Distributed Database (MSDD)," according to the notice.

Hispanic Women Lag in Weight, Heart Risk Knowledge

There is a disparity in the awareness of weight and the risk for heart disease between Hispanic and non-Hispanic white women, according to a study in the Journal of Women's Health.

Elsa-Grace Giardina, MD, of Columbia University Medical Center in New York City, and colleagues explored the issue in 683 women enrolled in the Heart Health in Action database who completed a questionnaire.

After accounting for age, education, and body mass index, Hispanic women were less likely to identify heart disease as the leading cause of death among women compared with non-Hispanic white women (27% versus 88%). Hispanic women also were less likely to correctly estimate their weight (69% versus 83%), with underestimation more likely for Hispanic women among the participants who were overweight (48.5% versus 12.7%) and obese (17.2% versus 0%).

"Efforts to enhance cardiovascular disease prevention strategies should focus on defining those who stand to benefit from educational messages. Persistently low cardiovascular disease awareness poses continuing challenges for Hispanic women, healthcare professionals, and public health officials," the authors wrote. "Education about cardiovascular disease, weight perception, and healthy weight are critical steps in addressing the relationship between obesity and the rise in cardiovascular disease mortality attributed to it."

TAVI Beneficial for Oldest Patients

Patients into their 80s and 90s can have good outcomes from transcatheter aortic valve implantation (TAVI), according to a study in the Annals of Thoracic Surgery.

Masanori Yamamoto, MD, of Henri Mondor University Hospital in Creteil, France, and colleagues examined outcomes among more than 2,200 patients, 80 and older, using data from the French national TAVI registry (FRANCE-2). They broke the population down into three age groups: 80 to 84, 85 to 89, and 90 to 101.

Procedural success, complications, and length of stay were similar among the three groups. And the rate of 30-day mortality did not significantly differ between the groups (10.3%, 9.5%, and 11.2%, respectively, P=0.53). Although the differences were not statistically significant, the rate of 1-year mortality was higher in patients ages 85 to 89 (26.1%) and 90 or older (27.7%) compared with those ages 80 to 84 (19.8%).

In a multivariate analysis, however, being in one of the older two age groups was not associated with mortality at either time point.

Mortality rates in all three groups "were acceptable considering the frequent comorbidities and advanced age in these patients," the authors wrote. "Transcatheter aortic valve implantation may be a good therapeutic option even in very elderly patients."

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